Provider Demographics
NPI:1164797056
Name:RECOVERY AT SEA
Entity Type:Organization
Organization Name:RECOVERY AT SEA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:RAMONA
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:DRAKE
Authorized Official - Suffix:
Authorized Official - Credentials:RAS II, CSC
Authorized Official - Phone:310-847-7606
Mailing Address - Street 1:700 ANCHORAGE ROAD
Mailing Address - Street 2:NEWMARKS YACHT CENTRE
Mailing Address - City:WILMINGTON
Mailing Address - State:CA
Mailing Address - Zip Code:90744
Mailing Address - Country:US
Mailing Address - Phone:310-847-7606
Mailing Address - Fax:310-847-7610
Practice Address - Street 1:2345 EAST 4TH STREET
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90814
Practice Address - Country:US
Practice Address - Phone:310-847-7606
Practice Address - Fax:310-847-7610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-12
Last Update Date:2012-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health